The concept of EMR is described and the problems of EMR application are analyzed including restrictions on change permissions and writing time of EMR, and sounds in medical record management mechanism to ensure legality and effectiveness of record. Based on improvement of national policy, third-party management services institutions are estab- lished and related suggestions on technical and environmental support of EMR development are provided, and the future of its development in our country are expected.

Objective To dump and recover the expired data in No.1 Military Medical Project, avoiding the waste of large amount of storage space and improving the operation performance of hospital information system. Methods After clearing the backup table, the data from the original table backup was put into the backup table. The data was unloaded from the backup table to a file, and then the file was saved. The data in the original table was deleted, but it could be restored to the table when needed, and the corresponding data could be obtained through the application program. Results The storage space was enlarged after data dump. Conclusion The dump of the expired data can make data management more scientific and hospital information system run more smoothly.

Adenoma, Liver Cell ; metabolism ; pathology ; Adolescent ; Adult ; Child ; Diagnosis, Differential ; Female ; Focal Nodular Hyperplasia ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Liver ; chemistry ; pathology ; Liver Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; Peptidyl-Dipeptidase A ; biosynthesis ; Young Adult

To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical advices of TCMs and supports for developing the TCM dispensing technology.
Chin ; Cooking ; Drug Administration Routes ; Drug Administration Schedule ; Drug Interactions ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; history ; Fever ; drug therapy ; history ; History, Ancient ; Humans ; Medicine in Literature

4-Hydroxycoumarins ; poisoning ; Acute Disease ; Adult ; Humans ; Male ; Poisoning ; diagnosis ; Prothrombin Time

Objective To investigate and analyze the experience of planting and maintaining implantable venous access ports(IVAP) in management of post-operative breast cancer patients. Methods Breast cancer pa-tients receiving IVAP after surgery from Mar. 2011 to Jun. 2014 were retrospectively analyzed. The relative com-plications were documented and summarized during implanting operation. Results 468 patients received IVAP, among whom 451 patients underwent piercing implantation via right internal jugular vein, 15 patients underwent piercing implantation via right subclavian vein, and 2 patients underwent piercing implantation via left internal jugular vein. The mean cathe tering leng th was 12.8 cm for patients receiving IVAP via right internal jugular vein, ranging from 12 to 15 cm. Thereinto, 30(6.4%) patients experienced shot-term complications including 16 cases of puncture difficulty, 5 cases of accidental arterial puncture, 2 cases of extravasation, 2 cases of blood aspiration dif-ficulty and 5 cases of arrhythmia. Three cases had long-term complications as the following:one case of catheter-re-lated infection, one case of catheter lost, and one case of incision rupture. Conclusions IVAP is a safe and effec-tive intravenous infusion device. It is crucial to choose individualized implanting access and length by professional surgical team.

Objective:To analyze the relationship of lipoprotein associated phospholipase A 2 (Lp-PLA2) and severity of coronary atherosclerosis, and evaluate the effects of rosuvastatin at different doses on the concentration of plasma Lp -PLA2.Methods: Totally 152 cases of patients with suspected coronary heart disease were treated with coronary angiography .According to the results of angiogra-phy, the patients were divided into the coronary heart disease group ( n=117 ) and the normal control group ( without coronary heart disease,n=35).Gensini integral scale was performed and referring to the number of diseased coronary arteries , the degree of coronary atherosclerosis was evaluated .The concentration of serum Lp-PLA2 was detected and the relationship of Lp-PLA2 and the severity of coronary plaque was evaluated .Meanwhile , the patients with coronary heart disease were divided into 2 groups and orally treated with rosuvastatin respectively at the routine dose (10 mg· d-1 ) and the loading dose (20 mg· d-1 ).The changes of the plasma concentra-tion of Lp-PLA2 before the treatment, in the 2nd, 4th,8th and 12th week after the medication were measured and the effect of atorvastatin at different doses on the plasma concentration of Lp-PLA2 was summarized .Results: The plasma Lp-PLA level in the control group was (22.22 ±1.75) μmol· ml-1, while that in the coronary heart disease group was (29.03 ±3.99) μmol· ml-1(P<0.05).The differences in Lp-PLA2 levels between the groups with different Gensini scores of coronary heart disease were statistically significant ( P<0.05).The higher scores were, the higher Lp-PLA2 levels were.The results of multivariate analysis showed that the severity of cor-onary atherosclerosis was significant and positive correlated with Lp-PLA2 level (OR=1.613,P<0.05).In the 2nd, 4th, 8th and 12th week after the medication , Lp-PLA2 levels in the loading dose group were significantly lower than those in the routine dose group ( P<0.05).In the 2nd, 4th, 8th and 12th week after the medication, the degree scores of coronary artery stenosis in the loading dose group were reduced.The decreasing range was significantly greater than that in the routine dose group (P<0.05).The incidence of adverse cardiovascular events in the routine dose group (27.12%) was significantly higher than that in the loading dose group (6.90%) ( P<0.05).The incidence of adverse drug reactions in the routine dose group was 11.86%, while that in the loading dose group was 18.97%(P>0.05).Conclusion:Lp-PLA2 is correlated with the severity of coronary plaque .High dose of rosuvastatin can reduce plasma Lp-PLA2 concentration in the patients .

Objective To investigate the repair and protective effect of extracorporeal membrane oxygenation (ECMO) on liver and bile duct after cardiac death in pig.Methods Eight pigs were purchased and cardiac arrest was induced by the administration of 1 g KCL intravenously,followed by 30 min cardiopulmonary resuscitation according to standard guideline.Cannulas were placed through inferior vena cava and abdominal aorta,and then connected to ECMO extracorporeal circulation pipes.ECMO was performed for 4 h.Circulation flow rate of hepatic artery and bile production were monitored and recorded.Lactate dehydrogenase (LDH),γ-glutamyl transferase (γ-GT) and direct bilirubin (DBIL) in bile were detected.Transaminase,tumor necrosis factor-α (TNF-α),interleukin-1β (IL-13),hyaluronic acid (HA),endothelin-1 (ET-1) and nitric oxide (NO) in serum were detected.Pathological change was observed by HE staining under optical microscope and cell apoptosis was detected by TUNEL.Results There was no bile production after cardiac death,which increased to 80％ of the baseline after 4h of ECMO.In addition,γ-GT,LDH and DBIL content in bile was (23.3 ± 11.8) IU/L,(15.9 ± 3.3) IU/L and (72.3 ± 21.4) mmol/ L,and IL-1,TNF-α and HA content in serum was (117.6 ± 39.0) ng/L,(120.4 ± 16.5) ng/L and (63.7 ± 4.4) ng/L,respectively,and no statistically significant differences were observed when compared with the baseline (all P ＞ 0.05).ET-1 content was (4.9 ± 1.3) ng/L and NO content was (135.3 ± 16.7)mmol/L in serum,which was statistically increased (both P ＜ 0.05).Pathological changes of liver and bile duct were significantly alleviated.Conclusion ECMO could exert protective effect on liver and bile duct after cardiac death.

AIM:To observe whether modified epitopes from pancreatic tumor antigen mucin 4 (MUC4) have HLA-A2-restricted antitumor ability.METHODS:RT-PCR and Western blot were used to identify the expression of MUC4 in the pancreatic tumor cell lines CAPAN-2 and ASPC-1.HLA-A2 epitopes from MUC4 protein were predicted by the software of NetCTL 1.2, BIMAS, SYFPEITHI and IEDB.The modified peptides from MUC4 containing HLA-A2 were obtained by replacing anchor residues of the binding anchor motifs.The peptides were synthesized by standard solid-phase methods.The binding affinity of the peptides to HLA-A2 molecule was evaluated by T2 binding assay.ELISPOT assay was used to investigate the ability of the peptide to induce specific restricted cytotoxic T-lymphocytes (CTLs) and release of IFN-γ.The ability of the peptides to induce T-cell response was investigated by cytotoxicity assay in vitro.RESULTS:The expression of MUC4 was observed in the CAPAN-2 cells and ASPC-1 cells.The candidate peptides P1944-1Y, P1944-2L, P1944-1Y2L, P2004 and P2004-1Y9V showed moderate affinity toward HLA-A2 molecule.T2 binding assay showed that P1944-1Y2L and P2004-1Y9V had significantly higher affinity for HLA-A2 than the native peptides.ELISPOT assay showed P1944, P1944-1Y2L, P2004 and P2004-1Y9V were able to induce specific CTLs and more amounts of IFN-γ were released.ELISPOT assay showed that significantly more amounts of IFN-γ released by P1944-1Y2L and P2004-1Y9V were observed than the native peptides.The CTLs induced by P1944, P1944-1Y2L, P2004 and P2004-1Y9V lyzed the CAPAN-2 cells.P1944-1Y2L and P2004-1Y9V peptide-specific CTLs showed higher cytotoxicity against pancreatic tumor cell line CAPAN-2 than the native peptide-specific CTLs.CONCLUSION:Compared with the native peptides, modified epitopes P1944-1Y2L and P2004-1Y9V have higher binding affinity with HLA-A2 and retain immunogenecity.In addition, the anti-tumor immunity of modified epitopes P1944-1Y2L and P2004-1Y9V is stronger than that of the native peptides.The peptides P1944-1Y2L and P2004-1Y9V are excellent HLA-A2-restricted CTL epitopes from tumor antigen MUC4, which could serve as new candidates towards antitumor peptide vaccines.

Objective To review the experience of perioperative management and effect of coronary artery bypass grafting (CABG) for patients of aged＞80 years.Methods We studied 118 cases with CABG for patients of age＞80 years from January 2002 to December 2012.The other 1034 cases with CABG for patients aged 60-80 years were enrolled as control group.Logistic regression analysis was used to assess the effect of age on operative mortality and morbidity.Results The recent mortality was higher in group aged＞80 years [6.8％(8 cases) vs.3.1％(32 cases)].Through multivariate logistic regression,the patients aged＞80 years versus control were concerned about some postoperative adverse events as follows:higher mortality (OR =3.45,95 ％ CI:2.86-4.23),dialysis (OR=3.56,95％CI:3.01-4.32) and re-intubation(OR=3.87,95％CI:3.45-4.87),delayed healing of incision(OR=4.05,95 ％ CI:3.47 5.74),prolonged mechanical ventilation(OR=3.76,95 ％ CI:3.435.01),prolonged ICU stay (OR =2.98,95 ％ CI:2.67 4.12),prolonged hospital stay (OR =2.87,95％CI:2.36-3.96).Conclusions Age＞80 years is an important factor of postoperative mortality and morbidity for CABG.We need pay more attention to perioperative management.